Laser minimally invasive technologies for pilonidal disease

AIM: to estimate results of minimally invasive laser procedures for pilonidal disease.

PATIENTS AND METHODS: the prospective randomized multicenter study included 154 patients with chronic and 76 patients with acute inflammation of pilonidal sinus. Patients were blindly divided into equal groups by simple randomization. Patients of group A underwent laser coagulation and curettage of the pilonidal sinus, in group B — sinus excision, in group C — laser coagulation through a wound, in group D — simple abscess opening. Laser radiation of a diode device with a wavelength of 1.56 microns with a power of 10–15 W was used.

RESULTS: the recurrence rate 1 year after laser coagulation and curettage of the pilonidal sinus was 5.2%. Significant advantages (lower pain level, wound infection rate, treatment duration, time of wound healing) of the sinus excision were revealed (p < 0.05 for all). Ultrasound control a year after procedure showed that the infiltrative changes of tissues in the postoperative area were significantly less common, as well as scar deformities of the intergluteal area (p < 0.0001; p = 0.006).No significant differences in wound healing time were revealed between groups C and D (p = 0.8). In group D, a secondary fistula was detected in 10.5% after a month of follow-up and required a sinus excision later. The disease remission rate was lowest in group C after 1 year of follow-up (p = 0.01). Morphometry and ultrasound after a year showed infiltration without fluid structures and inflammation in surgical site in group C in 7.9% of patients, in group D — in 23.7%.

СONCLUSION: the laser coagulation with curettage and laser coagulation through a wound has a number of advantages over the traditional procedures. These methods can become alternative options for chronic and acute pilonidal disease in regimen of “one-day surgery”.

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